Summary Osteoporosis is a well‐recognized complication of long‐term heparin (unfractionated) therapy. It has been suggested that the low molecular weight heparins (LMWH) have a lower potential to cause osteopenia than the unfractionated preparations. We report a case of a 29‐year‐old woman who developed osteoporosis and pathological fracture of lumbar vertebrae following treatment with low dose LMWH (dalteparin) for 3 months. The aim of this report is to alert clinicians to the potential risk of this complication with the prolonged use of LMWH preparations — an increasingly popular choice for long‐term anticoagulation.

Quinolones are increasingly used as prophylaxis in neutropenic patients to prevent serious Gram-negative septicaemias but practice is not uniform because of the controversial evidence as to their effectiveness. It is unclear if they are of real benefit in patients with short episodes of neutropenia such as those resulting from treatment for solid tumours and lymphomas. The concern over the use of ciprofloxacin in such settings is the increasing development of quinolone resistant Gram-negative bacteria. We have retrospectively analysed our bacterial isolate resistance patterns in the Queen Elizabeth Hospital (QE) and in the Haematology Department of the Aga Khan Hospital (AKU), Pakistan where all patients would receive ciprofloxacin prophylaxis when neutropenic. Seven out of 57 (12.2%) and 18 out of 55 (32.7%) Gram-negative organisms isolated from blood cultures at the QE and AKU Haematology Departments, respectively, were resistant to ciprofloxacin (P < 0.01). In the Birmingham community this was significantly lower (P < 0.01) (55 out of 6423: 0.85%). We also showed a higher level of E. coli resistance at the AKU (18 out of 31: 58%) where ciprofloxacin use was more widespread than at the QE (1 out of 11, P < 0.01). We conclude that ciprofloxacin should not be used indiscriminately.

Sickle cell [5+ thalassaemia is regarded as the mildest ofthe sickle cell haemoglobinopathy syndromes with a benign natural course. In contrast to sickle cell disease, severe life threatening complications are not usually associated with this genotype.

Background: One of the most common clinical problem encountered by physicians in clinical practice is dyspepsia. This symptom has great impact on quality of life of patients. There are numerous causes of dyspepsia, organic as well as functional. Endoscopy is the diagnostic test of choice in these patients. Aim: The aim of our study was to see the endoscopic findings in patients with persistent dyspepsia. Methods: Retrospective analysis of data of patients who underwent Esophagogastroduodenoscopy (EGD) for persistent dyspepsia was collected and evaluated. Results: There were 495 patients in our study, 244 females and 251 males, with a mean age of 41 years. Almost half of the patients belonged to 21-40 years age group. The most common endoscopic finding in patients with persistent dyspepsia was gastritis (n=219, 44.2%), followed by normal endoscopy (n= 94, 19%), incompetent lower esophageal sphincter (n=67, 13.5%), gastric malignancy (n=48, 9.7%). Ulcer disease was found in just 15 patients (3%). Conclusion: Most common endoscopic finding in patients with persistent dyspepsia was gastritis followed by normal endoscopy. Key Words: dyspepsia, endoscopy

Introduction: Coronavirus disease 2019 (COVID-19) has resulted in dramatic changes to healthcare delivery. Endoscopic activity has had frequent disruptions during this pandemic. The objective of the study was to see the influence of pandemic over the endoscopic activity. Methods: This retrospective analysis of endoscopic activity was undertaken at Nishtar Hospital Multan. Procedural analysis was done in the three months immediately after covid lockdown (1st April till 30th June 2020) and was compared to a similar period one year back. Results: Five hundred and fifty-four (68.5%) patients underwent endoscopic procedures during the three months of pre-COVID era, while this number reduced to half (n=255, 31.5%) patients during the covid pandemic. Even though the absolute number of Esophagogastroduodenoscopies (EGDs) reduced during the pandemic, patients were more likely to undergo EGDs during the COVID pandemic in contrast to the era before the pandemic (79% versus 66%, p = 0.002). The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p < 0.001). The most common findings were esophageal varices and portal gastropathy (non-significant difference during and before the pandemic). Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002).The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. However, no significant difference was found before and during the covid pandemic (41.7% and 45.8% respectively, p=0.72). Internal hemorrhoids were the most common endoscopic finding. Colon cancer diagnosis reduced from 10% to undetected during the pandemic period. Conclusion: COVID pandemic resulted in a considerable reduction in all types of endoscopic procedures. The majority of procedures were done for emergency indications like gastrointestinal bleeding. Rates of cancer detection were significantly reduced. MeSH: Endoscopy, COVID-19, Gastroenterology